Fast-track eligibility after ambulatory anesthesia: a comparison of desflurane, sevoflurane, and propofol.
This study was designed to test the hypothesis that using the less soluble volatile anesthetics, desflurane and sevoflurane, as alternatives to propofol for maintenance of anesthesia facilitates the ability of outpatients to achieve postanesthesia care unit (PACU) discharge criteria (i.e., fast-track eligibility) on arrival in the PACU after laparoscopic surgery. One hundred-twenty consenting women undergoing laparoscopic tubal ligation procedures were randomly assigned to one of three treatment groups. After a standardized induction of anesthesia and tracheal intubation sequence, anesthesia was maintained with either desflurane 2%-6%, sevoflurane 0.6%-1.75%, or propofol 50-150 microg x kg(-1) x min(-1) in combination with nitrous oxide 60% in oxygen. Recovery times, postanesthesia recovery scores, and the number and type of therapeutic interventions in the PACU were recorded. Compared with the propofol group, the times to awakening and to achieve a recovery score of 10 were significantly shorter, and the percentage of patients judged fast-track eligible on arrival in the PACU was significantly higher, in the desflurane and sevoflurane groups (90% and 75% vs 26%). In conclusion, compared with propofol, the use of desflurane and sevoflurane for the maintenance of general anesthesia resulted in a higher percentage of patients being judged fast-track eligible after outpatient laparoscopic tubal ligation procedures.


CONCLUSIONS
Bypassing the recovery room by transferring outpatients directly to the step-down unit after ambulatory surgery ("fast-tracking") could result in significant cost-savings. We examined the effects of three different maintenance anesthetics--desflurane, sevoflurane, and propofol--on the fast-track eligibility of outpatients after laparoscopic tubal ligation surgery. Compared with propofol, desflurane and sevoflurane resulted in a higher percentage of outpatients being judged eligible for fast-tracking.
Song
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Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.
Joshi
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GP
White
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PF
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D000077335:Desflurane; D004987:Ethers / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008738:Methyl Ethers; D009325:Nausea / Q000209:etiology; D010100:Oxygen / Q000097:blood; D011184:Postoperative Period; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D012119:Respiration; D000077149:Sevoflurane; D013246:Sterilization, Tubal; D013997:Time Factors
D004987:Ethers; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D010100:Oxygen; D015742:Propofol